3/03/2011 @ 6:00PM

Clayton Christensen: The Survivor

Clayton Christensen, 58, is one of the most influential business theorists of the last 50 years. The Harvard Business School professor’s 1997 book, The Innovator’s Dilemma, introduced in elegant terms the notion of “disruptive innovation,” which explains how cheaper, simpler or unexpected products and services can bring down big companies like U.S. Steel, Xerox and Digital Equipment. Every day business leaders call him or make the pilgrimage to his office in Boston to get advice or thank him for his ideas. A consulting firm he started popularizes his work, while a hedge fund run by one of his sons puts money to work betting on disruptive technologies.

One industry that always eluded Christensen’s influence was health care. Caregivers and insurers told him his theories didn’t apply to their complex industry. Christensen knew they were wrong. His investigation culminated in his 2009 book, The Innovator’s Prescription, written with two doctors. It exposed the many ways U.S. health care was broken and recommended numerous ways it can be systematized and disrupted the same way mainframes gave way to PCs and now iPhones.

Christensen’s work took on new urgency the past few years as he suffered a heart attack followed by cancer followed by a stroke. For Christensen it was not a reason to get too upset. It was another opportunity, in a lifetime full of them, to gain insight into how to make the world work better. Because of his July stroke it took a long time for Christensen to be ready to sit down with FORBES. He was in intensive speech therapy, eight hours a day at the beginning. But he graciously agreed to tell his inspiring story in January, the same month he went back to teaching. Here it is in his words, along with those of his family, friends and close colleagues.

Clayton Christensen

My dad died at age 49 from Hodgkin’s lymphoma. A wonderful dad. Even back then in 1975 the probability that it would go into remission was about 80%. So I happily went off to Oxford. Once I was there for six weeks it was clear that he was in trouble. The Rhodes Trust was just marvelous. I went to talk to the warden Sir Edgar Williams and after two minutes he said, “We’ll send you home. You can come back next week, next month, next year, ten years from now.” I was with my dad for the last two months before he died. It was the most wonderful, happiest experience of my life to take care of my dad.

He worked for a department store in Salt Lake City, ZCMI. As we were growing up he took us to work on Saturday to help him put the food on the shelves. I knew his job pretty well. I kept it up [after he got sick]. That kept us on the same salary and insurance. He dictated to me his life history. Most I’d heard before. I put it together into a biography. It’s been a wonderful thing. As my kids grew up, on Sunday morning I’d say, “Okay, guys, read pages 20 to 30 in Grandpa’s biography, and let’s talk about what it means for us.”

My mom also died of cancer. She was 82. That was just about five years ago. In the Mormon Church we believe we can be married for all eternity, not till death do you part. As Mom was getting older she was excited, truly excited, that within a few years she’d be with Dad again. I’ve known people who wanted to die, but most of them were so miserable they wanted to escape it. But in this case my mom was healthy. She didn’t want to live too long that she couldn’t take care of herself. She was so excited when her doctor said that she had pancreatic cancer and likely would only live six or seven weeks. She had a great life and a great family. “Now I can see your dad again,” she told me.

Ann Christensen (oldest daughter)

My dad is a perpetual student. He’d come home from work every day excited about some comment a student had made or a paper they had written. He’d say, “You’ll never believe what I learned today.” It turned into dinner table conversation.

Matthew Christensen (oldest son)

Too many of his former students who come back, too many people period, say family is important or my religious beliefs are important. But if you look at how they spend any given week, they spend 90 hours at work. They leave before their kids wake up and come back after they go to sleep. When my dad was at the Boston Consulting Group, he would go in superearly and come home early. He was famous for leaving early. We would play catch in the daylight.

Diabetes

Clayton

I got Type 1 diabetes at 30. It hit me in 1982 when I was a White House Fellow in Washington. I had viral pneumonia. I lost 35 pounds in six weeks. And I couldn’t see anything. Everything was blurry. I was always thirsty.

I called a friend who was a doctor in Boston, and he immediately diagnosed it: “Oh, you have diabetes.” I called my wife and said, “Oh, Christine, I am so relieved I have diabetes. I thought I was going to die of cancer.”

Diabetes is a great example whereby giving the patient the tools you can manage yourself very well. It’s been 28 years. If you have too much insulin your blood sugar drops and your brain shuts down. I’ve only lost consciousness four times in all of those years. The reason is that I test my blood sugar seven times a day. If it’s too low I have a Snickers bar. If it’s high I take a shot. I figure if I live a normal life I will take about 90,000 shots.

FORBES

The tips of Christensen’s very large fingers (he’s 6 feet 8 inches tall) are covered in black speckles from the pricks he gives them to test his glucose levels. These sorts of inexpensive, at-home care devices (Christensen has also used insulin drug pumps) are the kind of disruptive innovations the U.S. health care system needs to move out of the costly hospital and medical office setting. Disruption can replace a business that provides a service with a network that allows people to do it themselves.

Grant Bennett (friend for 32 years)

Overnight Clayton became an insulin-dependent diabetic. He would chart readings on a sheet of paper. He’d have an upper and lower control limit, trying to keep as close to the midpoint as possible. In the middle of a meeting he would prick himself, test his blood, and then inject himself in his arm or abdomen.

Heart Attack

FORBES

In November 2007 Christensen had a massive heart attack while the book The Innovator’s Prescription: A Disruptive Solution for Health Care was in its final stages as a manuscript.

Clayton

It was very strange because there was no evidence of any narrowing of my arteries. They were wide open. My bad cholesterol level is half the normal level. And my blood pressure is always on the low side. But a clot came from somewhere.

For seven years I was one of ten people who have responsibility for the Mormon Church in the northeast quadrant of North America. Almost every week I had to go to a city where all of the churches in the area [known as a "stake"] came together to have a conference. My job was to help them be better Mormons.

I got assigned to go to Montreal. The stake president in Montreal was a physician. We stayed at his home. At the meetings on Saturday the feeling of the spirit of God in that room was deeper than I have ever felt in my life. It was extraordinary. You walk out of it just committed to improve your lives for better.

We were sleeping in the extra room in their basement. At about 3 o’clock in the morning I just had a horrible pain in my chest. I never had a heart attack before. This was something bad. I was thinking, if I wake Christine and tell her, she’ll wake the stake president and they’ll take me to the hospital. It’s going to mess up a wonderful meeting on Sunday. And there are 1,000 members of the church who are going to come to that meeting. So I knelt down at the side of the bed and I said to God, “I have a problem. Whatever this is could you please just make it go away?” And it went away. I fell asleep and the meetings on Sunday were comparable to the ones on Saturday. The meetings ended about 9 p.m. on Sunday night, so then we started to drive back to Boston.

The next day was Veterans Day. I went and raked up the leaves. About 4 in the afternoon I had a horrible pain. [Christensen still hadn't told his wife about the episode the night before.]

Dr. Ryan Thompson (Christensen’s internist)

It was a major heart attack, the kind that leads to fatalities. It required immediate stenting. It was the real deal, the so-called widowmaker. Around a quarter of those who get those don’t make it.

Matthew

Our offices were in Harvard Square. I got a call from my mom, who’s crying. She says, “Meet me in the emergency room at Mount Auburn” [a community teaching hospital affiliated with Harvard]. He had his briefcase, papers to grade or articles to write. He is horrified about wasting time. It was a total shock. When your image of your dad is this indestructible guy, even when you’re 30, that’s how you think of him. Seeing him wheeled in on a gurney. It’s an image of vulnerability.

Dr. Jason Hwang (coauthor of the Innovator’s Prescription)

With angioplasty you blow up a balloon [in the artery] and it breaks up a clot. Angioplasty started with balloons that didn’t work that well because the vessel would clamp down. It had a very high failure rate. But then you added stents to reinforce the vessel, and then drug-coated stents, and the technology of angioplasty marched upward. As it gets better it can get more expensive, which opens the door to a new disrupter.

FORBES

After his heart attack Christensen bought a home INR meter, which measures how long it takes for blood to clot, so he could learn how to manage his Coumadin, a blood-thinning drug.

Clayton

The other option is to go down to the hospital. You sit there for 15 minutes, and then they draw the blood out. And they never say, “Sit here for five more minutes, and we’ll tell you the result.” Instead they put it over in the queue. Ultimately they do the sample, and then the result gets printed out on a sheet of paper. And what happens to that? Sometimes it goes to my personal doctor, who may or may not see it, or might see it and not know what initiated this in the first place. “Should I call the patient, should I go see him or pull him in?” The data doesn’t go to the person who knows exactly what to do with it. It helped me understand how wonderful and critical it would be to push care closer and closer to patients and their families.

FORBES

Christensen argues that hospitals should focus primarily on what he calls intuitive medicine, the process of figuring out what’s wrong with a patient. Once the treatment is set and can be routinized, that care should be transferred to lower-cost providers. The best way to do this is to have an integrated system, like what Kaiser Permanente runs in the western U.S., where the hospital owns the outlying clinics and surgery centers–and, ideally, also provides insurance. With more routinized care, nurses can be trained to do doctors’ jobs and specialty facilities can focus on driving out inefficiency with high-volume surgeries.

Cancer

Clayton

I was in Washington [in December 2009] with Christine. The church has a temple there on the Beltway, and at Christmastime they have jillions of lights decorating the gardens. We got invited to come down for the ceremony. That night we stayed near Reagan Airport, and at about two in the morning I had this awful pain in my lower back. I tried all kinds of different positions. Nothing seemed to help. At three I went down to a 7-Eleven. I got a bunch of ibuprofen. That didn’t work. When I was a high school senior I had an infection in my kidneys. And this thing felt exactly like that felt. So we came home on the first plane. I went immediately to a MinuteClinic. I thought, “I’ll just get a urine test.” It turns out in Massachusetts that MinuteClinics can’t do that. We had to go to Mount Auburn Hospital, the same place we took care of my heart attack. [The hospital] did the test. There was nothing that suggested infection. The head of the emergency is the same guy who orchestrated the care of my heart attack.

He started to feel my side. And basically, without telling me, he thought there was something big inside of me. He thought it was my aorta that had ballooned up. They very quickly did an ultrasound. They were all ready to cut me open and deal with an aneurysm. But the ultrasound showed that it wasn’t an aneurysm. He said, “I have some good news and some bad news. The good news is you don’t have an aneurysm. But you do have really big masses in there that feel forever like tumors.” So he said, “I’m sorry.” He was very kind.

FORBES

After consulting with Dr. Thompson and another physician friend, Christensen transferred to Massachusetts General, a Harvard-affiliated teaching hospital downtown. An oncologist met with Christensen that afternoon.

Clayton

The tumor in my abdomen was the size of a ball this big [mimes a football]. It was pushing against my back, and that’s what I felt. There was another one behind my sternum that was wrapped around my esophagus and it hadn’t yet started to squeeze things down, but it was poised to do that. The third one was behind my clavicle. It was about the size of a jewelry box. That’s the one they biopsied.

Matthew

Ephraim Hochberg, he’s the oncologist who oversaw all of my dad’s care, could not have been better. Hochberg told us, “From what you described, let me tell you what it is.” I remember the percentages added up to 110%–70% lymphoma, with three different types; 20% lung cancer. The others were, I think, sarcoma and small-cell cancer, or testicular cancer. Metastatic lung cancer was the worst-case scenario.

Clayton

They started doing all these tests. But this time I think I was more knowledgeable because The Innovator’s Prescription had been out, and a big theme of that is that the body has a limited vocabulary to draw upon to express that there’s a disease inside. There are many more diseases than symptoms. There are over 50 types of lymphoma. Dr. Hochberg, I love to listen to him. He describes how lymphoma respects the boundaries [of the lymphatic system]. It would rarely do something so rude as to invade another organ, which was great news for me. The lymph system is comprised of all of these tiny little tubes throughout my body that collect stuff. Now all of a sudden you have three big masses, but they were within the system that controlled them.

Dr. Ephraim Hochberg (Clayton’s lymphoma specialist)

Ninety percent of people will have microscopic evidence of lymphoma in their blood–90% of people. The question is why 99% of those people never get lymphoma. I got a phone call from [Christensen's] primary care physician asking if I could see a patient. When I went to meet him it was in the surgical waiting room. He was being prepped for a biopsy. He was remarkably composed and well-spoken.

FORBES

After the biopsy Christensen received a diagnosis of follicular lymphoma. It looked like a slower-growing variety, which would be less responsive to chemotherapy and more likely to be terminal.

Dr. Hochberg

[After some more testing] it turned out he had a variant of lymphoma that we described in a research paper five years ago. The cells look small, but the rate at which they divide as measured by another test is quite high. So there’s a potential that some might even be cured with a more aggressive type of chemotherapy. So we went from “It’s incurable” to a rare subtype of common lymphoma.

FORBES

Prior to Christmas Dr. Hochberg prescribed a cocktail of chemotherapy drugs plus Rituxan, a targeted antibody from Genentech. Christensen began getting infusions every three weeks for four and a half months. That spring semester he continued working, speaking and doing some teaching on a reduced schedule. After the first two rounds of chemotherapy, Christensen had several scans to see how the tumors had responded.

Dr. Hochberg

He had a dramatic response. His first scan he had a mass in his abdomen of 14cm by 8cm. On the second scan it was down to 8cm by 6cm–so, volumetrically, about a 75% response. The last scan we did showed the mass was down to 4cm by 3cm.

Clayton

It was actually really fun to see Dr. Hochberg. He let me in the office, excited about what he was learning. He truly was energized to teach it to me. He’s a true scientist. So he would never exaggerate. He showed me the data in such a very excited tone of voice. Before Rituxan came along, you could say probabilistically for the population that you’re going to be in remission for 4.3 years. If you keep taking Rituxan for maintenance, you’ve expanded the probability of it staying in remission out to 7 or 8 years. Dr. Hochberg raises the possibility that in my case it won’t come back. As he looks at what’s happening to my particular tumors, they just seem to be disintegrated. But you never know.

Stroke

FORBES

Christensen had been out of chemotherapy for three months. But on July 18, 2010, while giving a talk at 6:30 in the morning on a Sunday to a church group, he suffered a stroke.

Matthew

The stroke was the most distressing. I was at the church meeting. And one of the things that my dad loves to talk about in our church meetings is how to share the Gospel with other people. Midsentence he couldn’t talk. It was nonsense. I tried to help him sit down and put my hands around his arms. His face looked fine. We thought: “Gee, this might be a low blood sugar thing.” He keeps candy in his briefcase. I’m feeding him Skittles and Snickers. After about ten minutes he was not getting better. We tested his blood sugar. It was 325 [not low].

We went out in the hall. My friend Mike Preece [a neuroradiologist] came out with us and gave him a neurological exam. He held Dad’s hands with his fingers and said, “Can you squeeze my hands?” He said, “Yes,” but he couldn’t do anything. By the time we got to the hospital he couldn’t walk. I remember pushing him in a wheelchair.

FORBES

At Mass General Christensen, within an hour, received a clot-busting drug called TPA, which has been shown to help minimize stroke complications. The stroke managed to avoid the part of his brain that controlled his motor skills and analytical abilities. He did, however, lose his speech. In a recent lecture to HBS students, he described the sensation by comparing it to a file cabinet in his head filled with words–that is suddenly tipped over.

Matthew

While he was waiting for speech therapy he bought Rosetta Stone English. There’s an image of something on the software and you say the word. He’d have contests with my oldest daughter, Madeleine [6 years old]. He lost a lot.

Clayton

I’m an optimistic person. But for the first time in my life, with all my problems, I focused more and more on me–and it was depressing, literally. Sometimes I just wanted to quit trying to learn and speak and write again and just go into my basement and build furniture. I learned an important lesson from this. I learned that focusing on my own problems does not bring happiness. God didn’t say, “Okay. For those with problems it’s okay to focus on yourself. And for those who don’t have problems, I want you to focus on helping others.” Even in dire times God does not exempt me from his commandment to focus my life on others, because it transforms hardship to joy.

Dr. Hwang

The two doctors who co-wrote our book were both Democrats. Clay has been adamant that the Obama legislation creates more problems than it solves. Health care is very innovative in ways that we would call sustaining. We are careful to explain that the U.S. system is the best in the world. You’ll get superior treatment. But for marginal improvements in care you’re adding tremendous costs. The concern is in overshooting. To take care of people you need systems that are lower-cost. We need to free up beds, free up doctors and empower nurses.

Matthew

You could say it’s unfair that a guy who has worked so hard to be healthy could be slapped with a heart attack followed by cancer followed by a stroke. We believe there’s a reason for it.

Clayton

When science seems to contradict religion, then one, the other, or both are wrong, or incomplete. Truth is not incompatible with itself. When I benefit from science it’s actually not correct for me to say it resulted from science and not from God. They work in concert.